Worldwide, 143 million children are estimated to have lost one or both parents, 15 million to HIV/AIDS alone. Millions more children have been abandoned and are in need of care. The need to understand individual, family, community, and structural factors influencing positive outcomes for orphaned and abandoned children (OAC) across and within different cultures is pressing. The goal of this competing renewal application is to continue to follow an existing cohort of more than 3,000 randomly selected OAC in six culturally diverse study sites in Cambodia, Ethiopia, India (Nagaland and Hyderabad), Kenya, and Tanzania. Children enrolled in the Positive Outcomes for Orphans (POFO) cohort were aged 6-12 at baseline; half were enrolled from family settings, half from 83 institutional care settings. Children were followed for 2-3 years with a retention rate of >87%. POFO children will be aged 10-16 at the close of the study in May 2010 and are transitioning to adolescence and young adulthood, perfectly positioning the cohort to help us understand predictors of positive outcomes such as retention in school, employment opportunities, and civic engagement, and predictors of negative outcomes such as high risk sexual and drug use behaviors, early pregnancy, and engagement in sex trade. Many of the OAC in this cohort were orphaned or abandoned due to HIV/AIDS, the consequences of which may now place them at risk for engaging in behaviors that make them more likely to become HIV infected and/or spread the disease. We propose to follow this cohort for 4 years and examine the influence of intrapersonal, interpersonal, and community level factors on: 3 behavioral and relationship outcomes: HIV risk behaviors, reproductive health, and family formation, and 3 achievement outcomes: continued education, income generating activities (IGAs) and civic engagement. The cohort will be followed through ages 14-20 during the proposed study period. Building on the success of POFO I, which has received international attention, this application has the highest level of support from Duke University and organizations in each of the countries with which we have been working, and a study-specific Advisory Board has been formed to help guide POFO I analyses and POFO II design and implementation. A minimum of 7 peer-reviewed manuscripts, a major policy document, and a book will result from this study. These documents will advise policymakers, programmers, and researchers on the caregiving and cultural characteristics that need consideration when planning for the transition of millions of orphaned children from childhood into young adulthood. PUBLIC HEALTH RELEVANCE: The need to understand intrapersonal, interpersonal, and community level factors influencing positive outcomes for orphaned and abandoned children (OAC) across and within different cultures is pressing. This competing continuation for the Positive Outcomes for Orphans (POFO) study will identify such factors by continuing to follow more than 3,000 OAC as they transition to adolescence and young adulthood. The study is conducted over four years in six culturally diverse study sites in Cambodia, Ethiopia, India (Nagaland and Hyderabad), Kenya, and Tanzania.